Project Summary/Abstract Approximately 70,000 adolescents and young adults (AYAs) between the ages of 15 and 39 are diagnosed with cancer each year in the United States. As cancer incidence in AYAs continues to rise and the 5-year survival among most AYA cancers exceeds 80%, the population of survivors of AYA cancer is rapidly expanding. Survivors of AYA cancers, like all other cancer survivors, face risk of detrimental late effects of cancer and its treatment, including second cancers, organ failure, as well as other serious illnesses. Furthermore, as survivors of AYA cancer age, their risk of morbidity and mortality due to chronic comorbidities increase. It is thus prudent that health services to prevent the onset and progression of these chronic comorbidities be part of their integrated survivorship care plan. However, little is known regarding how care is delivered post-cancer diagnosis, particularly for survivors of AYA cancer. Given the need for evidence-based research to inform and improve survivorship care for survivors of AYA cancer, the overarching goal of this study is to advance our understanding on follow-up care for survivors of AYA cancer and identify areas to improve its quality. Our Specific Aims are (1) to examine the adherence to Children?s Oncology Group (COG) Long-Term Follow-up Guidelines (LTFG) by survivors of AYA cancer; (2) to examine the adherence to population preventive care guidelines by survivors of AYA cancer; and (3) to evaluate variations in adherence to COG LTFG and population preventive care guidelines among survivors of AYA cancer by individual-, provider-, and system-level factors. We will employ the rich resources of the Kaiser Permanente Southern California (KPSC), a large integrated healthcare delivery system that covers >1% of the US population. Detailed information regarding cancer therapeutic exposures, health service utilization, and patient-, provider- and system-level characteristics for 5,986 survivors of AYA cancer is available through KPSC?s electronic health records for accomplishing the proposed specific aims. This application leverages collaboration between investigators at KPSC and University of Alabama, with multidisciplinary expertise in cancer survivorship, health service research, epidemiology, biostatistics, and medical oncology. Completion of these aims will: (1) help to determine if survivors of AYA cancer receive appropriate follow-up and preventive services; (2) identify practice gaps that can be improved to deliver comprehensive cancer survivorship care; (3) provide evidence to inform policies to improve the quality of cancer survivorship care overall. Findings from this proposal will also serve as a basis for future research application to develop and test targeted multi-level interventions to directly improve the quality and coordination of care for survivors of AYA cancer.